Wednesday, 8 August 2012

Neighborhood Health Plan of Rhode Island has contracted with MedSolutions to provide authorization for Radiology services

Effective from May 1, 2010 select MR, CT, PET, and Nuclear Cardiac Imaging services requires prior authorization from MedSolutions.

Services require prior authorization

All outpatient, non-emergent, diagnostic advanced imaging services including:
  • CT
  • MR
  • PET
  • Nuclear Cardiology (NCM/MPI)
Services do not require prior authorization
  • Inpatient radiology
  • Radiology testing done in the Emergency Room
  • 23 hour observation
  • Outpatient radiology services other than those indicated
How can we request prior authorization from MedSolutions?

We can request authorization in three ways as below
  • Website       - (registration required)
  • Phone          -        888-693-3211 (Monday to Friday @ 8.00 AM to 9.00 PM EST)
  • Fax              -        888-693-3210 (fax forms available at MedSolutions web portal)
What we need to request authorization from MedSolutions?
  • The patient’s name & address
  • The current Member ID
  • The working or differential diagnosis
  • Prior tests, lab work and/or imaging performed related to this diagnosis
  • Notes from the patient’s last visit related to the diagnosis
  • Type and duration of treatment performed to date for the diagnosis
Authorization number will be faxed to ordering physician and requesting facility.